| NPI | 1215357033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 52599) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 57.025028) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY 52599) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.025028) | |
| Enumeration Date | 2014-04-19 |
| Last Update Date | 2020-07-28 |